Effect of age on therapeutic response and survival in advanced Hodgkin's disease

Although age is a recognized prognostic factor in advancerd Hodgkin's disease, there are few data concerning the use of combination chemotherapy in patients > 60 years. In two phase III trials of the cancer and Leukemia Group B, 385 previously untreated patients with stage III or IV Hodgkin's disease received multidrug chemotherapy. All patients received a combination of either mechlorethamine or a nitrosourea, as well as a vinca alkaloid, procarbazine, and prednisone. Two hundred and five patients were < 40 years of age, 107 were 40-59 years, and 73 were ≥ 60 years. The overal response rates in these three age groups were 70%, 66%, and 40%, respectively. Age at the time of diagnosis was the predominant factor affecting response, and the response rate was not significantly higher in those older patients who received full doses of chemotherapy. Age was also associated with an increased frequency of serious leukopenia and thrombocytopenia. The group of patients ≥ 60 years of age experienced the shortest median time to recurrence, 33 months. The intermediate age group also had a shorter time to recurrence (median, 44 months) than patients < 40 years (median not yet reached). The low complete response rate and the short duration of response in the patients ≥ 60 years of age resulted in a median survival time of 18 months. Even when the analysis is restricted to just the older patients who received ≥ 90% of the projected drug doses, the complete remission rate, the median time to recurrence (20 months), and the duration of survival (27 months) are still much shorter than in younger patients.